Patient Forms New Patient RegistrationTo make your first visit as smooth as possible, please submit the following forms online. New Patient Appointment Request Medical Records Request/Release Permission to Share Information Metabolic & Lifestyle Medicine Center New Patient RegistrationIn addition to the forms above, please submit the following forms online. MLMC Program Agreement MLMC Overview Consent MLMC Patient Intake Form Additional Forms and InformationAdvance Beneficiary NoticeAnorectal Manometry (ARM) ConsentAssignment of BenefitsHealth Information ExchangeHemorrhoid Banding ConsentHIPAAMedical Records Request/ReleasePelvic Floor ConsentPelvic Floor Financial PolicyPelvic Floor Referral and Prior Authorization Permission to Share InformationRelease of Billing/Financial PolicyShared Medical Appointment (SMA) ConsentTelemedicine Consent
